Accuracy of plasma interleukin-6 and C-reactive protein as markers of sepsis in preterm neonates with respiratory distress syndrome

Aim: To evaluate the diagnostic accuracy of plasma interleukin-6 (IL-6) and serum CRP in detecting blood culture proven sepsis in preterm neonates with respiratory distress syndrome (RDS).Patients and Methods: 140 preterm neonates, 62 with RDS and 78 without RDS, who developed clinical signs of sepsis were prospectively studied. Plasma IL-6 and serum CRP levels were measured. The ROC curves, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios (LR) were calculated for IL-6 (> 20 pg/mL and > 80 pg/mL) and CRP (> 10 mg/L).Results: Positive blood cultures were found in 64 neonates (37 with RDS and 27 without RDS). Neonates with RDS had higher IL-6 (p 20 pg/mL was 0,93, 0,65 and 2,68, respectively, in neonates without RDS, and 0,92, 0,16 and 1,09, respectively, in neonates with RDS. The sensitivity, specificity and LR of CRP > 10mg/L were 0,86, 0,71 and 2,97, respectively, in neonates without RDS and 0,73, 0,68 and 2,28, respectively, in neonates with RDS.Conclusions: In neonates without RDS both the IL-6 and CRP are equally accurate markers in diagnosing sepsis, whereas in those with RDS the diagnostic value of IL-6 is limited

Unusual site for iatrogenic esophageal perforation in a premature neonate

Esophageal perforation in the neonate period is uncommon and often iatrogenic in origin, requiring a prompt diagnosis in order to prevent further complications. We present a case of iatrogenic esophageal perforation in a premature neonate following orogastric tube placement. Findings on plain film radiograph were consistent with thoracic esophageal perforation. Due to the patient’s hemodynamic stability, the patient was treated nonoperatively with favorable results. We also discuss the cause, clinical clues to the diagnosis and treatment in cases with esophageal perforation

Cortical motor neurophysiology of patients with schizophrenia: A study using transcranial magnetic stimulation

Trancranial magnetic stimulation (TMS) provides a non-invasive means for exploring physiological alterations of central motor control in a variety of neuropsychiatric diseases. The present study aimed to assess the neurophysiological profile of muscle evoked responses to a standard TMS procedure in a considerable number of medicated patients with schizophrenia. Fifty-one patients with diagnosis of schizophrenia and 51 sex- and age-matched healthy subjects were enrolled in the study. Motor evoked potential (MEP) from abductor pollicis brevis muscle was elicited by stimulation of the contralateral motor cortex with a circular coil. The hot-spot was marked. Were measured: - the resting motor threshold (RMTh), - the stimulus intensity for maximum MEP (SI-max), - the post-stimulus silent period of voluntary muscle activity and - MEP latency and amplitude. The main findings were the significantly higher than normal values for RMTh and SI-max, which are both indices of neuronal excitability. In particular, patients who had ziprasidone in their therapeutic regimen demonstrated the highest SI-max for both hemispheres and highest RMTh for left hemisphere, patients receiving olanzapine demonstrated the lowest RMTh for left hemisphere and those on quetiapine showed intermediate values. Silent period was longer in the patients as opposed to controls when a RMTh-related SI was used and did not differ between the two groups when a fixed SI was used. We concluded that the observed TMS changes could be interpreted by primary alterations of intracortical motor excitability followed by defects of cortical inhibition and should be attributed to schizophrenia, antipsychotic medication or the interaction between both factors.H TMS διακρίνεται έναντι άλλων εργαλείων απεικόνισης λόγω της ικανότητάς της να ενεργοποιεί νευρώνες σε επιλεγμένες φλοιϊκές περιοχές. Η παρούσα μελέτη προσπαθεί να διερευνήσει το νευροφυσιολογικό προφίλ της μυϊκής προκλητής απάντησης διάμεσου διακρανιακής μαγνητικής διέγερσης (TMS) σε ένα σεβαστό αριθμό ασθενών με σχιζοφρένεια υπό φαρμακευτική αγωγή. Σε 51 ασθενείς υπό φαρμακευτική αγωγή και διάγνωση σχιζοφρένειας και 51 υγιείς μάρτυρες απόλυτα σύμφωνους ως προς το φύλο, το ύψος και την ηλικία με τους ασθενείς που συμμετείχαν καταγράφηκαν κινητικά προκλητά δυναμικά (ΜΕΡ) από τον απαγωγό μυ του αντίχειρα μετά τον ερεθισμό του αντίπλευρου κινητικού φλοιού με ένα κυκλικό πηνίο. Μετρήθηκαν: - RMTh (resting motor threshold): Ο ουδός κινητικής ηρεμίας, - SI-max (stimulus intensity for maximum MEP): Η ένταση ερεθίσματος που χρειάζεται για την καταγραφή του μέγιστου κινητικού προκλητού δυναμικού, - Post-stimulus silent period: Την ανερέθιστη περίοδο που επάγεται μετά από ένα ερέθισμα που προκαλεί συγκεκριμένη μυική δραστηριότητα, - MEP Latency: Λανθάνον χρόνος των κινητικών προκλητών δυναμικών MEP amplitude: Το εύρος των κινητικών προκλητών δυναμικών. Τα βασικά ευρήματα είναι η σαφώς υψηλότερη από τις φυσιολογικές τιμές, τιμή των RMTh και SI-max και τα δύο, ενδείξεις νευρωνικής ευοδωτικής δραστηριότητας στους ασθενείς σε σύγκριση με τους μάρτυρες. Ειδικότερα στην ομάδα των ασθενών που βρίσκονται σε θεραπεία με ζιπρασιδόνη παρουσιάστηκε το υψηλότερο SI-max και στα δύο ημισφαίρια και το υψηλότερο RMTh στο αριστερό ημισφαίριο. Οι ασθενείς στην ομάδα που ελάμβαναν ολανζαπίνη παρουσίασαν το χαμηλότερο RMTh για το αριστερό ημισφαίριο και αυτοί σε θεραπεία με κουατιεπίινη παρουσίασαν τιμές ανάμεσα στις τιμές των δύο προηγούμενων ομάδων. Όταν χρησιμοποιήθηκε ένταση ερεθίσματος (SI) σχετικής τιμής με το RMTh, η ανερέθιστη περίοδος βρέθηκε μεγαλύτερη στους ασθενείς από ότι στους μάρτυρες ενώ δεν παρατηρήθηκε καμία διαφορά ανάμεσα στις δύο μεγάλες ομάδες ασθενών και μαρτύρων όταν χρησιμοποιήθηκε σταθερής έντασης ερέθισμα (SI). Συμπεράναμε, ότι οι αλλαγές στις παραμέτρους που μετρήθηκαν, μπορούν να εξηγηθούν από βασικές μεταβολές της ενδοφλοιϊκής ευοδωτικής κινητικής δραστηριότητας που ακολουθείται από διαφοροποιήσεις της φλοιϊκής αναστολής, οι οποίες μπορούν να αποδοθούν είτε στην σχιζοφρένεια είτε στην φαρμακευτική αγωγή ή στην αλληλεπίδρασή τους

Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants

Background: In preterm infants with IVH the electrocortical background activity is affected and there is a correlation between the severity of cerebral injury to the degree of depression, however the usefulness of the early aEEG recordings has hardly been determined. Aim: To identify early aEEG features that could be used as prognostic markers for severe brain injury in prematures. Methods: In 115 infants, 25-32 wk GA, aEEG recordings during the first 72 h of life were correlated with head ultrasound findings. Continuity (Co), sleep-wake cycling (Cy) and amplitude of the lower border (LB) of the aEEG were evaluated by semi-quantitative analysis. Results: The infants were divided into four groups based on head ultrasound findings: A (n = 72, normal), B [n = 16, grades 1-2 intraventricular hemorrhage (IVH)], C (n = 21, grades 3-4 IVH) and D (n = 6, periventricular leukomalacia). 18 infants (16 of group C and 2 of group D) died during hospitalization. Significantly lower values of all aEEG features were found in group C infants. The presence of pathological tracings (burst-suppression, continuous low-voltage, flat trace) or discontinuous low-voltage (DLV), the absence of Cy and LB < 3 mu V in the initial aEEG displayed a sensitivity of 88.9%, 63% and 51.9% respectively, for severe brain injury. Logistic regression of aEEG features and GA to the presence or absence of severe injury revealed that only Co was significantly correlated to outcome. Using this feature 83.19% of cases were correctly classified. Conclusion: Pathological tracings or DLV in the initial aEEG is predictive for poor short-term outcome in premature neonates. (C) 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved

Association of increased maternal ferritin levels with gestational diabetes and intra-uterine growth retardation.

AIM: The objectives of the present study were to determine whether or not increased serum ferritin in women with premature labour is associated with gestational diabetes mellitus (GDM) and intra-uterine growth retardation (IUGR) and, if so, whether or not such increased levels reflect excess maternal iron stores, and have an effect on neonatal iron status and outcome. METHODS: This prospective, single-hospital, observational study involved 63 mothers and their 90 preterm neonates. Full blood counts as well as serum ferritin, soluble transferrin receptor (sTfR) and erythropoietin concentrations were compared across the three study groups based on maternal ferritin levels at the time of delivery. Perinatal history, neonatal morbidity and early outcomes were also assessed. RESULTS: High maternal ferritin levels were significantly associated with higher rates of GDM and IUGR. However, there was no correlation between maternal ferritin and sTfR levels or between maternal and neonatal iron status. CONCLUSION: Elevated maternal ferritin is not a reflection of excess iron stores, but is related to an increased risk of GDM or IUGR. Also, maternal ferritin levels are not associated with either neonatal iron status or neonatal outcomes. Copyright (c) 2009 Elsevier Masson SAS. All rights reserved